Some links and readings posted by Gary B. Rollman, Emeritus Professor of Psychology, University of Western Ontario

Thursday, December 27, 2012

Too Young to Have a Heart Attack - NYTimes.com

The foreshadowing escaped me: The night before we left for our summer vacation in Michigan, I accidentally stepped on my Kindle - which, like my heart, I cannot live without - and broke it. Reduced to reading novels on my iPhone, I made the best of it several days later, sitting in a sunroom overlooking Eight Point Lake, where my family gathers each year with friends.

The day before, proving to my teenage sons that 48 isn't too old for fun, I had hung on for dear life as I zoomed behind a speedboat on a ski tube. The next day, I was enjoying a few moments of solitude in those blissful minutes before the sun goes down, finger-swiping to turn the page of my novel on my phone's tiny screen, when my left arm started hurting.

You know that childhood feeling when your mother is mad at you, grabs your arm and squeezes it as she drags you away from whatever grief you've been causing? It felt like that, times 10, from shoulder to wrist. My chest got slightly uncomfortable, and I started sweating profusely. For the next four or five minutes, I kept to myself. I was incredibly antsy - up, down, sitting, standing, leaning, lying; my arm and I simply couldn't get comfortable.

I instinctively knew what was happening but wasn't ready to say it out loud, trying to reassure myself. There was no elephant on my chest; I'm too young - no one in my family has had heart trouble before age 55; I'm 50 pounds overweight but carry it well. Nevertheless, I motioned my husband up from the dock and, cradling my arm, told him something was really wrong.

He rushed to get some baby aspirin he'd seen earlier in the bathroom, which I chewed. I noticed him quietly doing a Google search for "heart attack symptoms" on his phone as family and friends gathered around us, but I was otherwise inside my head, no longer able to focus on what anyone else was doing or saying.

Our friend drove us to the E.R., where my EKG looked normal and the first nitroglycerin pill had no effect. But 10 minutes later, about the time the second and third nitro pill were making the pain dissipate, the doctor showed up with the result of my cardiac enzyme blood test. It's supposed to be 0, but mine was much higher. And, he said, that weird somersault feeling I was having right at that moment at the base of my throat was actually tachycardia, a rapid heart rate. Before he was even done talking, an ambulance crew was waiting to take me to a bigger hospital 30 minutes away for a cardiac catheterization.

A little balloon angioplasty through the groin? I could deal with that, and maybe I could convince them to let me go back to the cottage in time for dessert. Instead, I woke up the next day, struggling to breathe, wrists strapped to the rails of a hospital bed, hearing the word "surgery." I was extremely agitated, confused and unable to ask questions because of the breathing tube running down my throat.

This was not the summer vacation I had planned.

It turned out my "tortuous" left anterior descending artery was 95 percent clogged, and the angioplasty effort tore the inner artery wall, making a stent impossible and creating an even more critical situation. While I was still anesthetized, a surgical team was rounded up at 3 a.m. for an emergency heart bypass. In the span of a couple of hours, I went from expecting a teeny balloon in my artery and a little puncture in my groin to having open heart surgery and an eight-inch scar bisecting my chest.

Did I ever expect this? Not really. I'd read enough to know that heart disease is the No. 1 killer of women, that our heart attack symptoms often are radically different from men's (just ask Rosie O'Donnell, whose heart attack symptoms the same week as mine seemed more like the flu), and that a third of cardiovascular-disease deaths happen to people younger than 65. But this stuff doesn't happen to us, right?

Not only did it happen to me; it happened to me twice. I was lucky enough to arrange a flight home on a small plane -- larger planes have pressure issues, and the doctors wouldn't let us drive -- but 30 minutes into the flight, my left arm started hurting and I started sweating, not to mention crying at the thought of going through this all over again.

We made an emergency landing. Later, after five hours of tests and discussion, a doctor told me it was stress-induced angina: the symptoms of a heart attack without the life-threatening blockage. He wanted me to stay overnight for observation, but finally agreed to let me continue my trip home.

I'd been relatively pain-free in the hospital, but once I was home, the agony of my titanium-twist-tied sternum was startling. I've had to take everything -- shifting positions, showering, even breathing -- slowly. I'm more aware of my heartbeat, which can be a little freaky. And while I won't be running marathons any time soon, it's heartening to hear from friends that I look "terrific," nothing like a person who had a heart attack five months ago.

I've learned many things throughout all of this. Among them, that doctors now try to use a mammary artery, from the chest, for the bypass instead of grafting one from the leg because the mammary bypasses tend to last longer. And it's likely that a lot of my previous complaints over the past few years - extreme fatigue, lack of endurance, poor circulation, jaw pain (not T.M.J., after all), and so many other vague symptoms - were due to this growing accumulation of plaque in my artery, not perimenopause. Even though I'm far from healed yet, I feel amazingly more alert and less muddled than I did before the surgery, and many of those other symptoms suddenly disappeared.

I also quickly learned I have more friends than I realized, as people brought dinners and well wishes for weeks on end (not to mention commiseration about trying to read a book on an iPhone, a heart-attack-inducing event if ever there was one). However, I'm still coming to terms with the idea of a heart-healthy diet here in Wisconsin, the land of aged and artisan cheeses.

Perhaps most important, I've learned to relinquish some control. Even if your doctor says you don't need help walking up the stairs, let your husband or children escort you anyway. When you've been this close to death, the recovery is as much theirs as yours.